Liaison Continent Travel Medical Insurance

Schedule of Benefits

All coverages and plan costs listed in this brochure are in U.S. Dollar amounts.

Deductible

$0; $100; $250; $500; $1000; $2500

Deductible is per person per Policy Period, maximum of 3 Policy Period deductibles per family. The selected Deductible and Coinsurance amount must be met for your Policy Period, maximum six(6) months. (see Continuing Coverage)

Plan A: After you pay the deductible, the program pays 80% of the next $2,500 of eligible expenses, then 90% of the next $5,000 of eligible expenses, then 100% to the selected Medical Maximum.

Plan B: After you pay the deductible, the program pays 75% of eligible expenses to the selected Medical Maximum.

Outside the United States and Canada:

Plan E: After you pay the deductible, the program pays 100% to the selected Medical Maximum.

Plan F: After you pay the deductible, the program pays 80% of eligible expenses to the selected Medical Maximum.

Hospital indemnity

$150/ night, (traveling outside the U.S. and Canada) in addition to any other Covered Expense.

Dental (emergency)

$100 ($500 for accidents) Only available to programs purchased for one (1) month or more.

Emergency medical evacuation/repatriation

$300,000 (in addition to the Medical Maximum)

Home country coverage

Incidental Trips to The Home Country: $50,000

Follow me Home country coverage

$5,000

Return of Mortal Remains

$50,000

Emergency Reunion

$50,000

Return of Minor Children

$50,000

Political Evacuation and Repatriation

$50,000

Interruption of Trip

$5,000

Loss of Checked Luggage

$250

Local Ambulance Expense

$5,000

Accidental Death & Dismemberment

$50,000 principal sum for Insured or Insured Spouse

$5,000 for Dependent Child(ren)

Common Carrier Accidental Death

$100,000 Principal Sum for Insured or Insured Spouse

$25,000 per Dependent child(ren) under age of eighteen (18)
$250,000 Maximum per family

Hospital Room and Board

Usual, reasonable and customary to the selected Medical Maximum

Intensive Care

Usual, reasonable and customary to the selected Medical Maximum

Outpatient Medical Expenses

Usual, reasonable and customary to the selected Medical Maximum

Optional Hazardous Sport Coverage Rider

More Information

The following are covered if the required premium has been paid:

motorcycle/motor scooter riding (whether as a driver or passenger)

hang gliding

parachuting

bungee jumping

water skiing

snow skiing

snowmobiling

snowboarding

Parachuting shall mean an activity involving the breaking of a free fall from an airplane using a parachute.

Waiver of Pre-Existing Conditions

More Information

Up to $20,000 for U.S. citizens traveling outside the United States & Canada (refer to exclusion #1 for details)

For foreign nationals visiting the United States, up to $200 per day for each night spent in the hospital after being admitted for either a heart attack or stroke. Max. Benefit of $3,000 (refer to exclusion #1 for details)

Benefit Period

6 Months

* This Web page contains only a consolidated and summary description of all current benefits, conditions, limitations and exclusions. A certificate containing the complete Certificate Wording with all terms, conditions and exclusions will be included in the fulfillment kit. IMG reserves the right to issue the most current Certificate Wording for this insurance plan in the event this Web page, application, and/or brochure has expired, is modified, or is replaced with a newer version. Current Certificate Wordings are available upon request.